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Endoscopy (Monitoring Periods)

Printed From: Barrett's Support Forum
Category: Barrett's Support Forum
Forum Name: Barrett's Oesophagus
Forum Discription: Your Questions about Barrett's Oesophagus
URL: http://www.barrettscampaign.org.uk/forum//forum_posts.asp?TID=2048
Printed Date: 21 Nov 2019 at 9:38am


Topic: Endoscopy (Monitoring Periods)
Posted By: Scolly
Subject: Endoscopy (Monitoring Periods)
Date Posted: 11 Aug 2019 at 8:33pm
I’m new to this forum. I’m 68 and have had Barretts for 7 years. When I was diagnosed the checking period was one year, then it moved to two years and has now gone to three years, I was told by the doctor that they were being over cautious with the shorter period. My question is ‘What if my Barrett’s changes immediately after an endoscopy, will it get detected in time before it’s too late’. I ask this question because my father, eldest brother and now youngest brother have all died of cancer of the Oesophagus, my younger brother dying within five week of the diagnosis. I wasn’t concerned before but now since the death of my youngest brother I have become very concerned.



Replies:
Posted By: truthfreesall
Date Posted: 11 Aug 2019 at 9:03pm
Hi Scolly,

My advice would be to tell the doctor about your family history. Was your father or either brother diagnosed with Barrett's prior to esophageal cancer?

Also, how old were they when they passed?

These are things I would address with your doctor. Your family history, age and if you have a Hiatial hernia it would put you in a higher risk demographic which should be monitored more often.

Possibly (i'm just assuming) you have NDBO for the last 7 years which hasn't changed. This is why they spaced out your timing of Endoscopy surveillance. The belief is that if Barrett's is going to change and progress it does so within the first year of diagnosis. This is something I'm skeptical about because many doctors talk about frequent scoping and allocation of resources and look at it from a cost effective standpoint not really for the overall benefit of the patient standpoint. There's also the discussion in the medical community about the overall success rate in early detection with scoping. If I remember correctly only about 10% of the esophagus is surveyed using the Prague protocol. Chris can correct me if I'm wrong on this point.

My advice make an appointment tell your doctor about your family history and tell them you prefer to be scoped in a shorter interval. IDK how the system works in G.B. but I would also get a second even third opinion.


Posted By: chrisrob
Date Posted: 11 Aug 2019 at 10:58pm
Hi Scolly, I do understand your concern.
It is recognised that we scope far too freuently since the vast majority of scopes show no changes. It is actually quite unusual for changes to occur. Scoping intervals are suggested by British Society for Gastorenterology and may be seen https://sites.google.com/site/barrettswessex/treatment/guidelines - here , but they also take into account your familial history, body mass, anxiety level etc.
Please do not stress about the expanding time gap. As we understand the condition more, we can make netter choices.
Although I have a large Barrett's segment, I am happt to have agreed to 3 yearly scoping - and would be happy with longer intervals.
The main benefit of the scopes is the reassurance it gives patients. If your cells do start to mutate, you will probably start to notice a change in symptoms. Although Barrett's itself has no symptoms and actually protects us to a great extent, if pre-cancerous changes were t occur, there would be swelling of the tissue in the lower oesophagus impeding swallowing (though discernably different from the difficulties from strictures).
If you were ever to experience thse symptoms they'd fast track an appointment. Even if you did develop the cancer, it would normally be discovered whilst still possible to treat by ablation therapy. It's those who doon't know they have Barrett's who are most at risk as they typically won't present until their tumour has reached T4 when prognosis is just a matter of weeks.
As an extra note of encouragement, remember Barrett's does not progress. Although cells could mutate, the longer you have had them, the less likely they are to do so. Recent research has confirmed this. https://www.medpagetoday.com/meetingcoverage/ddw/65183 - This study suggests, "If Barrett's esophagus doesn't progress to dysplasia or adenocarcinoma over the first few years of endoscopic follow-up, it likely won't."

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk


Posted By: Scolly
Date Posted: 13 Aug 2019 at 1:37pm
Thanks for the information. I will be contacting my GP shortly an emphasising the family history, although it was raised when I was first diagnosed. My father was 57, eldest brother 75 and youngest brother 62 when they died.


Posted By: Scolly
Date Posted: 13 Aug 2019 at 1:38pm
Thank you for this information, comforting.


Posted By: truthfreesall
Date Posted: 13 Aug 2019 at 1:42pm
Sorry to hear that. Did any of them have Barrett's prior to progression?


Posted By: Scolly
Date Posted: 13 Aug 2019 at 2:27pm
None that was identified.


Posted By: chrisrob
Date Posted: 13 Aug 2019 at 3:13pm
We think all Oesophageal Adenocarcinoma may be from Barrett's cell mutations but we cannot know for certain because once cancer cells are there,they're no longer Barrett's cells and if there are any remaining Barrett's cells they'll be hidden under the tumour.

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http://www.barrettswessex.org.uk - www.barrettswessex.org.uk



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